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                  enGender Impact: The World Bank’s Gender Impact Evaluation Database



 Do Public Health Interventions Crowd Out Private Health Investments? Malaria Control
                                   Policies in Eritrea
      Author(s)            Pedro Carneiro, Andrea Locatelli, Tewolde Ghebremeskel and Joseph Keating
      Contact              jkeating@tulane.edu

      Country              Eritrea

  Organizing Theme         Health

       Status              Completed

Intervention Category      Malaria Control

       Sector              Health, Nutrition & Population
                           It is often argued that engaging in indoor residual spraying (IRS) in areas with high
                           coverage of mosquito bed nets may discourage net ownership and use. This is just a case of
                           a public program inducing perverse incentives. We analyze new data from a randomized
      Abstract             control trial conducted in Eritrea which surprisingly shows the opposite: IRS encouraged
                           net acquisition and use. Our evidence points to the role of imperfect information. The
                           introduction of IRS may have made the problem of malaria more salient, leading to a
                           change in beliefs about its importance and to an increase in private health investments.
 Gender Connection         Gender Informed Analysis

  Gender Outcomes          Use of healthcare services

     IE Design             Clustered Randomized Control Trial (Clustered at village level)
                           The intervention involved the control of adult mosquito populations using Indoor Residual
    Intervention
                           Spray with the insecticide DDT. The spray targeted all households in a village.
 Intervention Period       June- July 2009
                           The sample was drawn from 58 treatment and 58 control villages in Gash Barka Zone. A
  Sample population        random sample of 15 houses was selected in each village. There were 870 households in
                           each the treatment and control.
                           58 villages in Gash Barka Zone were randomly assigned treatment and 58 villages were
Comparison conditions      randomly assigned as the control group and received other malaria prevention service, but
                           not Indoor Residual Spray.
   Unit of analysis        Household Level

  Evaluation Period        October, 2009
                           This paper adds to Keating et al. (2011) to provide behavioral results to the IRS campaign.
                           The study finds that public provision of Indoor Residual Spray does not crowd out private
       Results             investment of malaria control in Eritrea. Public provision of spray does not reduce
                           ownership or use of bednets, if anything, the spray led to an increase in preventative
                           behaviors.


   Last updated: 14 August 2013                                                                      1
                   enGender Impact: The World Bank’s Gender Impact Evaluation Database


                            The study design was post-test only and may have failed to capture important pre-test
                            differences. Since the rate of malaria is so low, very large sample sizes are needed to detect
Primary study limitations
                            impact. The data was collected at the end of peak malaria transmission season possibly
                            biasing the results downwards,
                            World Bank HAMSET II grant, DIME, Economic and Social Research Council Center for
    Funding Source
                            Microdata Methods and Practice, The European Research Council,
                            Carneiro, P., Ghebremeskel, T., Keating, J., & Locatelli, A. (2012). Do public health
      Reference(s)
                            interventions crowd out private health investments? Malaria control policies in Eritrea.
    Link to Studies
                            http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2153408
       Microdata




    Last updated: 14 August 2013                                                                        2